Yes, Kevin, the comorbidities are a problem that should not be ignored. Some, perhaps many, of these patients started using opiates to avoid anxiety, depression, panic attacks, etc. As a psychiatrist you have the advantage of greater knowledge concerning treatment of these problems.
The people with chronic pain often go through years of pain clinics or doctors just prescribing repeated prescriptions for opiates. When they discover that bupe can relieve much of their pain and they can actually think and work again, they are overjoyed and will refuse to go to a pain clinic. I just saw a man yesterday who has a terribly unstable knee joint who is going for knee replacement surgery. He is more afraid of getting another opiate and getting attached to it than he is of the operation and postoperative pain itself. He says bupe has saved his life and his family, so his most dreaded fear is getting addicted to another opiate again. I tried to reassure him that this will not happen and that the knee surgery must occur if he is to avoid more repetition of accidents on the job by his slipping and falling.
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